Care providers are working in a “sea of regulatory dysfunction”, a new report has warned as its analysis suggested six in 10 homecare organisations in England either have out-of-date ratings or have not been rated by the healthcare watchdog at all.

As of June this year, more than a third (37%) had last been rated after an inspection by the Care Quality Commission (CQC) between four and eight years ago, while almost a quarter (23%) had never been rated, according to the Homecare Association.

The organisation, which has some 2,200 members across the UK providing social care for people in their own homes, criticised what it called a “sea of regulatory dysfunction”, likening the situation to restaurants which have not been visited by health inspectors in years.

Headshot of Dr Jane Townson
Dr Jane Townson has done her own analysis of homecare regulation (UKHCA/PA)

The analysis comes after an interim report published in July found “significant internal failings” affecting the CQC’s ability to identify poor performance at hospitals, care homes and GP practices.

That review, led by Dr Penny Dash, found some organisations had not been reinspected for several years, with the oldest rating for an NHS hospital dating from more than 10 years ago while the oldest for a social care provider was from 2015.

It prompted Health Secretary Wes Streeting to brand the CQC “not fit for purpose” and in need of “radical reform”.

The full independent report is due to be published in autumn.

In the meantime, a new report published on Friday by Dr Jane Townson, Homecare Association chief executive, said the “failure” of the CQC to carry out inspections and give ratings “risks harm” to those being cared for.

She said some providers have lost contracts and face going out of business as a result of “outdated or non-existent” ratings as well as delays in registering with the CQC.

Her report said while the number of registered community social care locations had soared in the past decade – from 2,303 in 2013 to 12,574 in June this year – the regulator’s resources have remained “largely static” and it is therefore struggling to cope.

It added that local authorities had encouraged “a proliferation” of small homecare providers – with 85% having fewer than 50 employees and 51% fewer than 10 – and that this has increased challenges around having enough staff to carry out inspections.

Dr Townson said the situation had resulted in some councils now having contracts with unassessed and unrated providers while others are not allowing such providers to bid for work.

The report stated: “Failure of CQC to fulfil its responsibilities risks harm to people drawing on services and to the growth and sustainability of care provision.

“It also risks damaging public perception of the quality and safety of homecare services.”

The report pointed to “flaws in CQC’s funding model and fee structure”, and what it described as “ineffective” IT systems and leadership.

Dr Townson said: “The state of homecare regulation in England is like a ship taking on water, with a crew using buckets instead of pumps to bail it out.

“People relying on care services are at risk of being left adrift, while dedicated care providers are fighting to stay afloat in a sea of regulatory dysfunction.

“Imagine running a restaurant where health inspectors haven’t visited in years, yet you’re still expected to maintain the highest standards with no feedback or support.

“That’s the reality for many care providers today.”

She recommended a “lifeboat of resources” for the CQC, including modernised systems, and a realistic understanding of regulatory costs.

She said her organisation is ready to work with the CQC but that Government must “chart the course” for improvement.

The CQC’s interim chief executive, Kate Terroni, said the regulator had accepted “in full” the findings and recommendations of the Dash report and pledged to work “at pace and in consultation with our stakeholders to rebuild that trust and become the strong, credible, and effective regulator of health and care services that the public and providers need and deserve”.

She added: “We’ve committed to increasing the number of inspections we are doing so that the public have an up-to-date understanding of quality and providers are able to demonstrate improvement.”

The CQC said it is also increasing the number of people working in registration, and is working to improve on current IT systems.

A Department of Health and Social Care spokesperson said: “It is completely unacceptable that homecare services are not being properly inspected. The Secretary of State has been clear there is an urgent need for rapid improvements at the Care Quality Commission (CQC) to give people confidence that the care they’re receiving has been assessed.

“This has already started with increased government oversight and the appointment of Professor Mike Richards to examine the assessment framework.

“We are determined to grip the crisis in social care. We will reform the sector and take steps to create a National Care Service.”